PROJECT SUMMARY/ABSTRACT Title: Voice Rest Adherence after Phonomicrosurgery The goal of this proposal is to examine adherence to post-surgical voice rest and the factors that affect it. Voice rest is an essential component of rehabilitation after phonomicrosurgery for benign lesions, and is thought to allow the vocal folds to heal and minimize scar tissue. There are currently no standards or guidelines for duration and type of voice rest prescribed. Current recommendations are based primarily on clinical experience and vary by physician, speech pathologist and clinical setting. Estimation of adherence to the prescribed recommendation is based on patient reports at the end of the voice rest period and can be highly variable and subjective. A small number of studies have shown poor levels of adherence to voice rest. This non-adherence has been one of the primary obstacles to accurately measuring surgical and voice rest outcomes and, creating standardized protocols for voice rest. There is also no information on factors that affect adherence such as barriers and supports, impact on quality of life, personality etc. The primary aims of this study are to measure subjective and objective adherence for two types of voice rest (complete voice rest (CVR) and relative voice rest (RVR)) immediately after phonosurgery and, predictors and factors associated with level of adherence. In the absence of specific guidelines for both voice rest types, adherence will be indicated by amount of voice use on voice rest. This will be a randomized controlled trial on fifty participants undergoing phonosurgery. Aim 1 of this study will compare patient- perceived adherence using patient reports to estimated voice use measured objectively by a vocal dosimeter for the 7-day voice rest period. These two measures of adherence will be compared within and between the CVR and RVR groups. Aim 2 will identify voice rest factors associated with high or low levels of adherence. Pre-operative factors include demographic information, scores on auditory-perceptual and patient ratings of voice, motivation, level of talkativeness, personality and, perceived control. After completing 7 days of VR, data will be obtained on impact on quality of life, alternate modes of communication used, economic impact, supports and barriers. These factors will be compared between CVR and RVR and also as predictors of level of adherence. Data from this study will be useful on multiple levels. It will provide empirical data on adherence differences between the two types of voice rests recommended and the difference between patient perception and measured adherence. In addition, clinicians can tailor their treatment to maximize post-surgical outcome if they can proactively identify predictors of poor adherence and modify their voice rest recommendations, increase patient education pre-operatively or include a period of trial therapy when feasible. The inclusion of adherence in the decision making process for voice rest recommendations is critical as we work towards developing guidelines for post-surgical voice recommendations.